MEDICARE: ROBBIE DIANE THOMAS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	372500000X	Chore Provider		NV

General Provider Information

NPI Number	:	1083056519
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBBIE DIANE THOMAS

Provider Business Mailing Address
First Line	:	1200 W CHEYENNE AVE
Second Line	:	# 1041
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7819
Country	:	US
Telephone Number	:	702-782-4562
Fax Number	:

Provider Business Practice Location Address
First Line	:	1200 W CHEYENNE AVE
Second Line	:	# 1041
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89030-7819
Country	:	US
Telephone Number	:	702-782-4562
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/25/2013
Last Update Date	:	01/16/2014

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Directions to “ ROBBIE DIANE THOMAS ” Practice Location

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